Nana Petroula, Spanos Konstantinos, Brodis Alexandros, Kouvelos George, Rickers Carsten, Kozlik-Feldmann Rainer, Giannoukas Athanasios, Kölbel Tilo
Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
German Aortic Center Hamburg, Department of Vascular Medicine, University Hospital Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2025 Jun;32(3):548-557. doi: 10.1177/15266028231179919. Epub 2023 Jun 7.
Endovascular treatment of aortic coarctation (CoA) constitutes a valuable alternative with low morbidity and mortality. The aim of this systematic review and meta-analysis was to assess the technical success, re-intervention, and mortality after stenting for CoA in adults.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and PICO (patient, intervention, comparison, outcome) model were followed. An English literature data search was conducted, using PubMed, EMBASE, and CENTRAL, until December 30, 2021. Only studies reporting on stenting, for native or recurrent CoA, in adults were included. The risk of bias was assessed using the Newcastle-Ottawa Scale. A proportional meta-analysis was performed to assess the outcomes. Primary outcomes were technical success, intra-operative pressure gradient and complications, and 30-day mortality.
Twenty-seven articles (705 patients) were included (64.0% males, 34.0±13.6 years). Native CoA was present in 65.7%. Technical success was 97% (95% confidence interval [CI], 0.96%-0.99%; p<0.001, =9.49%). Six (odds ratio [OR]: 1%; 95% CI, 0.00%-0.02%; p=0.002, =0%) ruptures and 10 dissections (OR: 2%; 95% CI, 0.001%-0.02%; p<0.001, =0%) were reported. The intra-operative and 30-day mortality were 1% (95% CI, 0.00%-0.02%; p=0.003, =0%) and 1% (95% CI, 0.00%-0.02%; p=0.004, =0%), respectively. The median follow-up was 29 months. Sixty-eight re-interventions (OR: 8%; 95% CI, 0.05%-0.10%; p<0.001, =35.99%) were performed; 95.5% were endovascular. Seven deaths were reported (OR: 2%; 95% CI, 0.00%-0.03%; p=0.008, =0%).
Stenting for CoA in adults presents high technical success and the intra-operative and 30-day mortality rates were acceptable. During the midterm follow-up, the re-intervention rate was acceptable, and mortality was low.Clinical ImpactAortic coarctation is a quite common heart defect that may be diagnosed in adult patients, as a first diagnosis in native cases or as a recurrent after previous repair. Endovascular management using plain angioplasty has been associated to a high intra-operative complication and re-intervention rate. Stenting in this analysis seems to be safe and effective as is related a high technical success rate, exceeding 95%, with a low intra-operative complication and death rate. During the mid-term follow-up, the re-interventions rate is estimated at less than 10% while most cases are managed using endovascular means. Further analyses are needed on the impact of stent type on endovascular repair outcomes.
主动脉缩窄（CoA）的血管内治疗是一种具有低发病率和死亡率的有价值的替代方法。本系统评价和荟萃分析的目的是评估成人CoA支架置入术后的技术成功率、再次干预情况和死亡率。
遵循系统评价和荟萃分析的首选报告项目声明及PICO（患者、干预措施、对照、结局）模型。使用PubMed、EMBASE和CENTRAL进行英文文献数据检索，直至2021年12月30日。仅纳入报道成人原发性或复发性CoA支架置入术的研究。采用纽卡斯尔-渥太华量表评估偏倚风险。进行比例荟萃分析以评估结局。主要结局为技术成功率、术中压力梯度和并发症以及30天死亡率。
纳入27篇文章（705例患者）（男性占64.0%，年龄34.0±13.6岁）。原发性CoA占65.7%。技术成功率为97%（95%置信区间[CI]，0.96%-0.99%；p<0.001，I²=9.49%）。报告了6例破裂（比值比[OR]：1%；95%CI，0.00%-0.02%；p=0.002，I²=0%）和10例夹层（OR：2%；95%CI,0.001%-0.02%；p<0.001，I²=0%）。术中死亡率和30天死亡率分别为1%（95%CI，0.00%-0.02%；p=0.003，I²=0%）和1%（95%CI，0.00%-0.02%；p=0.004，I²=0%）。中位随访时间为29个月。进行了68次再次干预（OR：8%；95%CI，0.05%-0.10%；p<0.001，I²=35.99%）；95.5%为血管内干预。报告了7例死亡（OR：2%；95%CI，0.00%-0.03%；p=0.008，I²=0%）。
成人CoA支架置入术具有较高的技术成功率，术中及30天死亡率可接受。在中期随访期间，再次干预率可接受，死亡率较低。
临床影响
主动脉缩窄是一种相当常见的心脏缺陷，可在成年患者中诊断出来，无论是原发性病例的首次诊断还是先前修复后的复发。单纯血管成形术的血管内治疗与较高的术中并发症和再次干预率相关。在本分析中，支架置入术似乎是安全有效的，因为其技术成功率高，超过95%，术中并发症和死亡率低。在中期随访期间，再次干预率估计低于10%，而大多数病例采用血管内方法处理。需要进一步分析支架类型对血管内修复结局的影响。
